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Causes of recurrence of paediatric inguinal hernia after single-port laparoscopic closure
Chao-Sheng He1, Yi Su1, Ming-Xue Liu1
1First Affiliated Hospital of Xiamen University, Xiamen, China.
Insights
Improper ligation is the main cause of recurrent paediatric inguinal hernia (PIH) after single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC). Ensuring tension-free, complete PIH ligation and avoiding peritoneal skip areas are crucial for surgical success.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Hernia Repair
Background:
- Paediatric inguinal hernia (PIH) recurrence can occur after surgical repair.
- Single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC) is a minimally invasive technique for PIH.
- Understanding recurrence factors is essential for improving surgical outcomes.
Purpose of the Study:
- To investigate the causes of PIH recurrence following SPLPEC.
- To identify factors contributing to surgical failure in PIH repair.
- To evaluate the effectiveness of redo-laparoscopic surgery for recurrent PIH.
Main Methods:
- Retrospective review of 3480 children undergoing SPLPEC for PIH (2015-2020).
- Comparison of outcomes between SPLPEC with single-hook vs. double-hook needles.
- Analysis of recurrence causes through redo-laparoscopy and intraoperative video review.
Main Results:
- A total of 39 recurrences (1.12%) were observed.
- The recurrence rate was significantly higher in the single-hook needle group (3.11%) compared to the double-hook group (0.67%).
- Primary causes of recurrence included incomplete peritoneal closure (14 cases), uneven ligation tension (10 cases), and loose ligation (8 cases).
Conclusions:
- Improper ligation techniques are the primary drivers of PIH recurrence after SPLPEC.
- Tension-free and complete ligation of the internal ring, avoiding peritoneal skip areas, are critical for successful PIH repair.
- Redo-laparoscopic surgery is an effective treatment for recurrent PIH, with options like direct ligation of the internal ring incorporating the medial umbilical ligament for giant hernias.
Purpose:
This paper explores the causes of paediatric inguinal hernia (PIH) recurrence after single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC).
Method:
From January 2015 to December 2020, the clinical data of 3480 children with PIHs who underwent SPLPEC were retrospectively reviewed, including 644 children who underwent SPLPEC with a homemade single-hook hernia needle from January 2015 to December 2016 and 2836 children who underwent the SPLPEC with a double-hook hernia needle and hydrodissection from January 2017 to December 2020. There were 39 recurrences (including communicating hydrocele) during the 2-5 years of follow-up. The findings of redo-laparoscopy were recorded and correlated with the revised video of the first operation to analyse the causes of recurrence.
Result:
Thirty-three males and 6 females experienced recurrence, and 8 patients had a unilateral communicating hydrocele. The median time to recurrence was 7.1 months (0-38). There were 20 cases (3.11%) in the single-hook group and 19 cases (0.67%) in the double-hook group. Based on laparoscopic findings, recurrence most probably resulted from multiple factors, including uneven tension of the ligation (10 cases), missing part of the peritoneum (14 cases), loose ligation (8 cases), broken knot (5 cases), and knot reaction (2 cases). All children who underwent repeat SPLPEC were cured by double ligations or reinforcement with medial umbilical ligament.
Conclusion:
The main cause of recurrence is improper ligation. Tension-free and complete PIH ligation are critical to the success of surgery, which requires avoiding the peritoneum skip area and the subcutaneous and muscular tissues. Redo-laparoscopic surgery was suitable for the treatment of recurrent inguinal hernia (RIH). For giant hernias, direct ligation of the internal ring incorporating the medial umbilical ligament (DIRIM) may be needed.
